This initiative has been generously supported by the Spencer F. & Cleone P. Eccles Family Foundation

“We will emphasize those issues that have for too long gone under-studied by scholars and under-reported in the mainstream media. And we hope to begin conversations that will lead to some salutary results.”

– David M. Kennedy, Historian and faculty co-director of the Bill Lane Center for the American West

With this blog post, we introduce Robin Pam. She is the co-author of our essay on rural health care and will be appearing from time to time with posts on the on-going problems in western rural health care. She is the director of operations at a health data start up in the San Francisco area. She has worked in health policy on a congressional committee, online communications at a think tank, a political campaign in Montana, and historic architecture at Yosemite National Park. Her writing has been published by the Center for American Progress and High Country News. Robin holds a degree in American Studies from Stanford, and is a native of the West.

– John McChesney

By Robin Pam

The House voted last week to eliminate more than $230 million in funding to graduate medical education residency training for primary care providers in community health clinics. The Affordable Care Act, 2009’s landmark health care reform law, mandated the funds for a five-year period, from 2011-2015. The bill under consideration, H.R. 1216, would eliminate the program’s automatic funding and shift the money into an appropriation subject to annual renewal in Congress.

The legislation is unlikely to advance in the Democratic-controlled Senate, and the Obama administration recently issued a statement indicating that it “will strongly oppose legislation that attempts to erode the important provisions” of the health care law.

Still, the threatened funding cut comes at a time when states across the nation are coping with shortages in primary care physicians. These physicians work in rural communities at much higher rates than specialists. The shortage of primary care providers is felt particularly in the rural West. Approximately 20% of Americans live in rural areas, while only 9% of physicians practice there. Large swaths of the rural West are designated as primary care Health Professional Shortage Areas.

Training more primary care physicians is the first step toward addressing persistent shortages. Exposing medical students and residents to rural settings during training—as the ACA program intends to encourage—is one of several important factors in a physician’s decision to practice in a rural area.

Many states are also facing funding cuts for primary care training from state governments. Texas plans to cut funding to its family practice residency programs by 70 percent over the next two years. In Utah, the number of family practice residencies available at the University of Utah—the only medical school in the state—has decreased from 12 to 8 in the past several years. During the recession the state also eliminated a loan repayment program that helped students who chose to serve in rural areas and with the National Health Service Corps, said Marc Babitz, Director of the Division of Family Health and Preparedness at the Utah Department of Health.

Babitz says that we won’t see the effect of those cuts for several years on long-term provider decisions to stay in rural areas, since the last loans are just running out. But he does say that he knows several students who have not gone into rural care because that loan repayment is no longer available. “We never had a problem spending all the money,” he says. “There were plenty of applicants.”

Rep. Dennis Cardoza, who represents portions of California’s Central Valley, said last week that his district would lose important funding for training needed physicians should the House legislation succeed. He offered an amendment to study the impact that eliminating the funding would have on the number of primary care physicians trained.

“Studies have shown that the most effective way to attract and retain new doctors in underserved areas is to allow medical students to complete their residency program in the communities that are in need,” said Cardoza in a floor speech. “Without these critical investments, the lack of care will most certainly have a costly price on the health and well-being of many rural underserved communities, including those I represent.”